Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2878
Peer-review started: March 17, 2018
First decision: April 18, 2018
Revised: May 2, 2018
Accepted: June 9, 2018
Article in press: June 9, 2018
Published online: July 14, 2018
Endoscopic submucosal dissection (ESD) is becoming the standard treatment for early gastrointestinal cancers, as it has a higher en bloc resection rate and a lower recurrence rate than endoscopic mucosal resection (EMR). However, when treating large mucosal lesions, ESD always faces many difficulties, such as multiple submucosal injections times, long procedure time, and low complete resection rate. To overcome these difficulties, a modified technique named endoscopic submucosal tunnel dissection (ESTD) has been proposed. Compared with ESD, ESTD could reduce the number of submucosal injections, shorten the procedure time, increase the resection speed, and reduce the injury of the muscular layer. However, there are no studies that verify the feasibility of ESTD in superficial esophageal squamous cell carcinoma (ESCC) and precancerous lesions in a large sample.
To our knowledge, the present study is the largest sample research of ESTD technique to date, and our observation indicators are complete, the follow-up period is long, the results are credible, and there is strong reference significance in clinical work.
This study aims to evaluate the clinical outcomes of patients who underwent ESTD for ESCC and precancerous lesions.
ESTD was performed in 289 patients with 311 lesions. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.
A total of 311 lesions were included. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate, postoperative bleeding rate, the perforation rate, and the postoperative infection rate were 6.43%, 1.61%, 1.93%, and 9.65%, respectively. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period.
ESTD for ESCC and precancerous lesions is feasible and relatively safe, but the rates of esophageal stricture and positive margin are high for large mucosal lesions.
The present study is a retrospective study to describe the general characteristics of ESTD. In the future, case control studies and prospective studies are considered necessary to evaluate further the feasibility and safety of ESTD for treating ESCC and precancerous lesions.